MEDICARE: ANAM CARA THERAPIES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	8909	MN

General Provider Information

NPI Number	:	1245504091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANAM CARA THERAPIES, PLLC

Provider Business Mailing Address
First Line	:	3646 14TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-2712
Country	:	US
Telephone Number	:	612-462-3812
Fax Number	:	612-573-6682

Provider Business Practice Location Address
First Line	:	3646 14TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-2712
Country	:	US
Telephone Number	:	612-462-3812
Fax Number	:	612-573-6682

Authorized Official
Title or Position	:	CLINICAL DIRECTOR AND THERAPIST
Name	:	CARA LYNN CARLSON
Credential	:	PH.D., MSW, LICSW
Telephone Number	:	612-462-3812

Provider Enumeration Date	:	02/25/2012
Last Update Date	:	06/17/2015

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